Application

Where did you see this position advertised?

Are you legally entitled to work in New Zealand?

If you answered "No" to the Work Permit question above please be aware that (if successful) you will have to contact NZ Immigration to have this changed to reflect the Whakatane District Council as the approved Employer before you are able to commence employment with us).

If you hold a Work Permit is it valid for you to work for the Whakatane District Council? (This means that it is not made out for any employer other than the Whakatane District Council)

Please indicate which of the following qualifications you have attained

Please list any specific skills or attributes you have relevant to this position that have not been identified in your CV.

If you are applying for a position which requires a license or certificate to practice (eg. specific trades), please indicate below if you have any pending restrictions or suspensions on your current professional registration

If you answered "Yes" to the question above relating to professional registration, please provide details:

If you have you previously worked for the Whakatane District Council please list any former roles below.

Please list below any positions that you have applied for over the last two years with the Whakatane District Council.

Have you undergone /Are you undergoing any internal or external disciplinary proceedings, investigations or complaints?

If you answered "Yes" to the question above relating to disciplinary matters, please give details below. Please also note any other matter(s) that may relate to your competency.

Are you currently under investigation by a professional body OR have you ever been the subject of a profession disciplinary enquiry by a professional body?

If you answered "yes" to the question above relating to investigations please provide details below:

Have you ever been dismissed from any employment?

If you answered "yes" to the dismissal question above, please provide details:

In accordance with the Clean Slate Act, do you have any previous or pending criminal, or other, charges or convictions (including drink or drug related driving convictions)?

If you answered "yes" to the Convictions question above, please provide details below:

Have you had or do you currently have any injury or medical condition caused by gradual process, disease or infection that may recur and / or affect your ability to carry out the duties of the position for which you are applying e.g. hearing loss, sensitivity to chemicals, occupational overuse injuries, back injuries, etc

If you answered "Yes" to the Health question above please provide details below:

If selected for a role: would you be prepared to undergo a pre-employment drug test and/or medical check?

Please indicate if you have entered into bankruptcy or any material accommodation with creditors?

Do you have a valid drivers licence?

If "yes", what classes do you hold?

Do you have any pending driving offences or loss of demerit points, if so please detail?

Please indicate if you have a relative/close friend or household member currently employed by Whakatane District Council, or in a situation that could cause a conflict of interest if you are appointed.

If required, do you consent to the Whakatane District Council undertaking the following security checks? Criminal History/Police Checks, Drivers Licence, Credit Checks, Dismissal Register, Other (if relevant)

Please give names and contact phone numbers of at least two (2) work related referees, preferably where there has been a direct reporting relationship (i.e: Supervisor/Manager)if not already captured in your CV.

Following the interview process; do you consent to the Whakatane District Council seeking verbal or written information on a confidential basis about you from the referees stated above or from within your CV for the purposes of ascertaining your suitability for this position?

I consent to the Whakatane District Council obtaining confidential, verbal or written information about me from my nominated referees or the author of any written reference or statement of service that I have provided for the purpose of assessing my suitability for this position. I declare that the information I have supplied in this application (and other supporting information including the attached CV)is true to the best of my knowledge. I accept that false declaration or failure to disclose relevant information could result in immediate dismissal. I also understand that any false information given in relation to my medical history may result in my loss of entitlement for any compensation from the Whakatane District Council's or other workplace insurer. By stating your name below means you agree to this above declaration.